Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | P0857 | TX |
Y | 208000000X | Pediatrician | P0857 | TX |
N | 2080A0000X | Adolescent Medicine | P0857 | TX |
NPI | 1154303139 |
---|---|
Provider Name | Dr. Kesturkoppal Muralidhara |
First Address | Mcallen, TX 78504-2262 |
Second Address | Mcallen, TX 78504-2262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
215664802 | (05) | TX |
296117901 | (05) | TX |
296117902 | (05) | TX |